OBJECTIVES: To estimate the budget impact of dabrafenib + trametinib (TAFMEK) market entry for patients with BRAF V600E-mutant advanced non-small cell lung cancer (NSCLC) from a US third-party payer's perspective.

METHODS: Costs of treatment (drug and drug administration), monitoring, adverse events (AEs), progression, terminal care, and BRAF testing were estimated over three years under the scenarios with and without TAFMEK entry. Published epidemiology data were used to estimate the targeted population size. BRAF test rate was assumed to increase by 5%, 15% and 20%, respectively, for the first three years with TAFMEK entry. Existing first-line treatments included bevacizumab combination therapy, platinum doublet, pembrolizumab, and best supportive care (BSC). Treatments in the second-line included bevacizumab combination therapy, docetaxel, erlotinib, pemetrexed, platinum doublet, nivolumab, pembrolizumab, and BSC. Model inputs were collected from published trials, drug labels, public data sources, and assumptions. All costs were estimated in 2016 USD.

RESULTS: In a hypothetical plan with 1 million members, an estimated 5.3, 6.6 and 7.2 patients in the overall population (first- and second-line) would be diagnosed with BRAF V600-mutant advanced NSCLC in Year 1, 2, and 3 with TAFMEK entry, respectively. In Year 1, TAFMEK increased treatment costs in the overall population by $0.0142, monitoring costs by $0.0002, and BRAF test costs by $0.0011 per member per month (PMPM), but decreased AE costs by $0.0001 and progression and terminal care costs by $0.0017 PMPM, resulting in a net increase of the total budget of $0.0137 PMPM. The budget impact was $0.0304 and $0.0369 PMPM in Year 2 and Year 3, respectively.

CONCLUSIONS: TAFMEK entry for BRAF V600E-mutant advanced NSCLC is expected to increase treatment, monitoring and BRAF test costs, which are partially offset by reductions in AE costs and progression and terminal care costs. The estimated total budget impact to US payers was modest.